TCSPP student Sonya Bruton and her work at Community Clinic, Inc.

January 22, 2015

For many of the primarily low-income, uninsured clientele who utilized Community Clinic, Inc. (CCI) in Franklin Park, Maryland between September 2013 and July 2014, TCSPP Doctoral Extern Sonya Bruton, MPA, MA was likely their one source of mental health care as they struggled through the vagaries of anxiety and depression. Working at CCI for her externship, Bruton was the only therapist within the primary medical care practice, a community-based, health care agency serving both underinsured and uninsured patients. The nonprofit with nine locations offers patients both physical and mental health interventions. Serving as a member of the primary care health delivery team, Bruton supplied both traditional and behavioral therapy to a patient population that had more than its fair share of people in extreme distress.

“Nearly all of my patients had gone through some form of trauma or intense heart ache,” said Bruton. “The traumas involved witnessed murders, captivity, sexual abuse/assault, physical assaults, stalking and domestic violence.”

Bruton, who worked at the practice twice a week and saw six to eight patients per day, including some from other CCI locations, realized that the need was already beyond what she alone could reasonably handle, and that it would grow even greater after she left. She recognized that when her externship ended her patients would need clinicians who could be available to them on a more permanent basis, and she decided to do something about it.

“I knew that the greatest service I could provide was the means to make sure that I was replaced and that overall services were enhanced.”

In a brilliant and thoughtful move that would ensure that not only her patients would get the mental health care that they need, but that all nine of CCI’s sites could integrate primary care and behavioral health, the fourth-year doctoral student presented her therapeutic work and outcomes as a pilot project, and used the data to write a federal grant proposal on behalf of CCI. Her proposal won CCI a Health Resources and Services Administration (HRSA) grant of $250,000 per year for two years. The grant, which will auto-renew after two years as long as CCI is in compliance, and once desperately needed, is now very much appreciated.

“The Behavioral Health expansion grant that Sonya procured for CCI is a game-changer for our agency and patients,” said Kathleen Knolhoff, CCI’s CEO. “Until this grant was funded, CCI provided very limited behavioral health services contracted through another agency. This grant has allowed us to hire a program director with national experience in integrating primary care and behavioral health services. She has begun hiring staff that will provide group and individual counseling, as well as participation as part of the patient centered care team in each of our health centers. ”

A game-changer indeed. Because of the HRSA grant, the agency has also been able to hire a part-time adult and child psychiatrist that will provide consultation for the agency’s primary care providers. Because the practice can now hire all their positions directly instead of going through an agency for contract staff, $110,000 has been freed from the budget to hire employees.

Bruton couldn’t be happier with the outcome of her efforts. “Adding staff is a significant improvement, but the addition of group therapy is equally important. Groups will not only allow more people to be seen, but they will also foster connection for community members who are suffering from the same wounds in isolation. Their treatment goals will be more quickly met in communion with each other.”

Bruton was placed at CCI by Aspire Health-Mobile Med Primary, an agency that CCI once contracted with for behavioral health support. She delivered both traditional 50-minute individual and couples therapy sessions, and worked with some patients using 30-minute behavioral health consultations for issues that might be helped through behavioral, cognitive or emotional changes. Though she was busy and contributing to their care, Bruton didn’t always feel like she was giving her patients the best level of care she could.

Ninety-five percent of her clients were monolingual Spanish speakers, neither speaking nor understanding any language other than Spanish. Bruton adds, “A significant percentage of them were undocumented and had arrived at the clinic for treatment within two weeks or two years of entering the country.” An interpretation method was put in place, but Bruton felt that the system, instead of helping, was actually impeding her efforts to care for her clients.

Called Language Lines, the program incorporates sentence frames to increase a student’s English-language fluency. For Bruton, it was far from helpful, as it prevented her from interacting directly with her clients.

“I grew frustrated with the barriers that it created for care. With the encouragement and support of my supervisor, I dropped that crutch and relied on my Spanish language skills,” said Bruton. “I had studied Spanish formally and informally for more than 12 years, but I had never used the language professionally. Supportive supervision allowed me to take that step.”

The decision to rely on prior learnings and skills proved to be one of the best decisions Bruton made during her time at CCI. She treated 61 patients during her tenure, and felt more confident that she was actually helping because she was speaking their language.

Clearly someone who will go beyond the norm for her patients, Bruton has been described by her supervisor, Licensed Clinical Psychologist Dr. Jen Sermoneta as someone who “brings such strong mental organization, discipline, excellent writing and personal commitment.” Continued Dr. Sermoneta, “It seems clear that she will eventually be at the top of her field.”

CCI’s CEO Knolhoff did not supervise Bruton’s therapeutic work, but did work with her on the grant for HRSA and says she considers her to be more than just an employee. She sees her as “a treasured colleague.” When asked where she thought Bruton would be in her career in five years, Knolhoff said, “Wherever she wants to be.”